This week's
problem is addressed by Jon Moses, MHA. Mr. Moses is President and CEO of
MDReview which he co-founded. He is a former hospital CEO with over 25 years
senior healthcare leadership experience.
Problem:
"Our medical staff is often frustrated by receiving what seem like complete peer review reports only to realize that not all information was provided to the reviewer for consideration. They are left making determinations based on what seems like shaky conclusions."
Solution:
One of the most important characteristics of high integrity peer review programs is the recognition that peer review is a process, not a report. This might sound very basic, but too often, time limitations, carelessness or simple avoidance lead to actions that are based on peer assessments without determining that the peer's conclusions are sound. Upon consideration of the peer review report, disciplined peer review committees ask these questions:
- Does the report reflect a thorough understanding of the case and care provided?
- Were the questions posed to the reviewer clearly answered in the report?
- Did we pose all the questions we want answered?
- Were all relevant records provided to the reviewer? If not, what impact might this have had on the assessment?
- Given the assessment and conclusions reached, are there any additional questions we would like to pose to the reviewer?
Ideally, complete medical
records, other relevant information and well thought out, complete questions
are provided to the reviewer in advance. This reduces the chances that follow up inquiries are necessary or that
the reviewer reaches erroneous conclusions. Incomplete or inaccurate information submitted for review can result in
an incomplete or faulty assessment. However, even when all information is provided and the questions are
clear, additional communication can be warranted.
The bottom line is
this: The peer review committee must
feel comfortable that the final conclusions reached by the reviewer are clear,
well supported and based on all important and relevant information. If this is not the case, then the process
should continue until a reasonable level of comfort is reached. This might include one or more of the
following:
- Submission of additional information for further consideration and comment.
- Written questions submitted to the reviewer for written responses.
- Inviting the reviewer to participate in a conference call with individual medical staff leaders or with a committee.
Peer review is a process. Given the important role that peer review can play in medical staff quality improvement and patient safety, the process should not stop until the review meets the complete satisfaction of medical staff leadership.
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